Winter of Crisis Killing the Elderly in Portugal

LISBON, Mar 19 2012 (IPS) - This winter the mortality rate in Portugal has grown alarmingly, to a level far higher than the seasonal averages of previous years. And the brunt of the death toll is being borne by low-income elderly people. The General Directorate of Health (DGS) reported that 11,600 people died in February, 1,600 more than in the same month in previous years. Most of the victims were over 75.

Public health experts say the record number of deaths is associated with the economic crisis and the draconian cuts in public spending made as a condition for the multi-billion dollar bailout of Portugal in 2011.

Free access to public health services, one of the major achievements of the Apr. 25, 1974 “Carnation Revolution” that ushered in democracy after a 48-year dictatorship, is in danger.

In September 2011, Health Minister Paulo Macedo reported that one-third of the country’s public hospitals were insolvent.

And under the terms set by the “troika” that granted the 110 billion dollar bailout – the International Monetary Fund (IMF), the European Union (EU) and the European Central Bank (ECB) – the government agreed to cut healthcare spending by at least five percent in 2012.

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Explanations for the rise in fatalities vary. According to the DGS, they are the result of the unusually cold weather and seasonal diseases.

But many doctors maintain that the increased number of deaths is also due to the growing inability of people to afford an adequate diet and proper healthcare.

Ana Filgueiras, head of the NGO Cidadãos do Mundo and coordinator of its mutual assistance programme for the youngest and oldest members of the community, commented on the situation in an interview with IPS.

“The significant rise in preventable deaths is due to a perverse combination of factors that are not new, but arose simultaneously and took elderly people, especially the poorest, by surprise,” she said.

She explained that in Portugal “there are large areas devoid of people of working age, which isolates older people, and especially the poorest among them, in conditions of basic survival and scant access to health services.”

This winter was particularly cold and dry, “bringing together the conditions that aggravate respiratory problems, to which the older population is particularly vulnerable. In addition, seriously reduced incomes this year meant they could not heat their homes to a minimally acceptable level.”

Filgueiras does not accept the government’s explanation, which blames the excess deaths on the flu.

“This year there were fewer flu cases, especially of the aggressive viral strains we have had in recent years, like influenza A-H1N1 (‘swine flu’),” so all the indications are that “real difficulties caused by the present crisis are preventing poor elderly people from paying for transport, fees and medicines to look after their health.”

“This combination of factors is really what has caused the deaths of older citizens,” the activist said.

Dr. Jaime Teixeira Mendes, a member of the board at Santa María Hospital, the country’s biggest, sees things in a similar light.

“The cold wave and the flu epidemic in our country are doubtless responsible for the higher mortality over the past month,” he told IPS in early March.

However, the doctor said these elements alone “cannot explain the figures, because there have been years in which the number of flu cases registered was similar, but the difference is that now there are enough flu vaccines, and this year more people were vaccinated.”

He quoted a World Health Organisation (WHO) study that “indicates the existence of a scientifically proven relationship between the social and economic conditions of a population, and its health.”

It is the austerity measures implemented in Portugal “that are responsible for the nutritional deficit, caused by higher food prices, bad housing conditions, and the absence of heating because of higher electricity prices,” he said.

Added to these are “difficulties in access to healthcare, because of hikes in transport costs and hospital fees, which have been proved by public health experts to be causes of higher mortality among the elderly,” Teixeira Mendes concluded.

On Mar. 3, the newspaper O Correio da Manhã quoted elderly patients who summed up the dilemma faced by Portugal’s poor: “We can buy food or medicine, but not both.”

Over the last two weeks, the Lisbon daily Público has devoted several pages to reporting on the precarious situation of the poor, who make up one-quarter of Portugal’s 10.6 million people.

The main focus has been on the difficult conditions faced by the elderly, and medical experts interviewed by the newspaper all related the rise in the mortality rate to the crisis and the cuts in public spending on health demanded by the IMF, EU and ECB.

Mario Jorge Santos, the head of the Portuguese Association of Public Health Physicians (AMSP), said the rise in mortality among older people was also due to soaring price hikes for electricity and gas.

Many elderly people, who are the most vulnerable to hypothermia, have tried to make their paltry pensions stretch farther by cutting down on heating.

According to the head of AMSP, poverty levels affect peak mortality rates, “whether by hindering access to healthcare or by making it impossible for people to keep warm.”

Santos said the rise of mortality in Portugal partly reflects “the decline in household incomes and the increase in patients’ fees,” which affect access to healthcare.

The AMSP states that raising hospital fees during a period of worsening economic conditions adds to the burden on healthcare services and, therefore, increases the death rate.

Francisco Vieira, a columnist for the newspaper Notícias Ribeirinhas, deplored the fact that many people “do not have adequate living standards, do not have effective healthcare, are not eating properly, are not heating their homes or wrapping up warmly, do not go out, do not socialise, do not smile and have no hope – a set of circumstances that can kill. Can anyone doubt this?”